Notice of Privacy Practices

Effective February 24, 2015


If you have any questions, please contact our Privacy Office at the address or phone number at the bottom of this notice.

Our pledge to you

We understand that medical information about you is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care that we maintain, whether created by facility staff or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office. Federal law requires us to:

  • Keep medical information about you private.
  • Give you this notice of our legal duties and privacy practices with respect to medical information about you.
  • Follow the terms of the notice that is currently in effect.

Changes to this Notice

We may change our policy policies at any time. Before we make a significant change in our policies, we will change our notice and post the new notice in waiting areas, exam rooms, and on our Website at You can receive a copy of the current notice at any time. The effective date is listed just below the title. A copy of the current notice is available for you upon request. You will also be asked to acknowledge in writing your receipt of this notice.

How we may use and disclose medical information about you

  • We may use and disclose medical information about you for treatment (such as sending medical information about you to a specialist as part of a referral); to obtain payment for treatment (such as sending billing information to your insurance company or Medicare); and to support our health care operations (such as comparing patient data to improve treatment methods, providing information to Joint Commission for Accreditation of Healthcare Organizations).
  • We may use or disclose medical information about you without your prior authorization for several other reasons. Subject to certain requirements, we may give out medical information about you without prior authorization for public health purposes, abuse or neglect reporting, health oversight audits or inspections, research studies, funeral arrangements, organ donation, workers’ compensation purposes and emergencies. We also disclose medical information when required by law, such as in response to a request from law enforcement in specific circumstances, to avert a serious threat to health or safety, or in response to valid judicial or administrative orders.
  • We also may contact you for appointment reminders, or to tell you about or recommend possible treatment options, alternatives, health-related benefits or services that may be of interest to you, or to support fundraising efforts.
  • If admitted as a patient, unless you tell us otherwise, we will list in the patient directory your name, location in the hospital, your general condition (good, fair, etc.) and your religious affiliation, and will release all but your religious affiliation to anyone who asks about you by name.  Your name will appear on a religious affiliation/church list and may be disclosed only to a clergy member representing your church or to your church representative, and even if they do not ask for you by name.
  • We may disclose medical information about you to a friend or family member who is involved in your medical care or to disaster relief authorities so that your family can be notified of your location and condition.

Disclosures of Mental Health Records

If your records contain information regarding your mental health, we are restricted in the ways that we can use and disclose them. We can disclose such records without written permission only in the following situations:

  • If the disclosure is made to you (unless it is determined by a physician that the release would be detrimental to your health);
  • Disclosure to our employees in certain circumstances;
  • For payment purposes;
  • For data collection, research, and monitoring managed care providers if the disclosure is made to the division of mental health;
  • For law enforcement purposes or to avert a serious threat to the health and safety of you or others;
  • To a coroner or medical examiner;
  • To satisfy reporting requirements;
  • To satisfy release of information that are required by law;
  • To another provider in an emergency;
  • For legitimate business purposes;
  • Under a court order;
  • To the Secret Service if necessary to protect a person under Secret Service protection and
  • To the statewide waiver ombudsman.

Other uses of medical information
In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing information about you. If you chose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision.

Your rights regarding medical information about you

  •  In most cases, you have the right to look at or get a copy of medical information that we use to make decisions about your care, when you submit a written request. If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.
  • If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the records, by submitting a request in writing that provides your reason for requesting the amendment. We could deny your request to amend a record if the information was not created by us; if it is not part of the medical information maintained by us; or if we determine that record is accurate. You may appeal, in writing, a decision by us not to amend a record
  • You have the right to a list of those instances where we have disclosed medical information about you, other than for treatment, payment, health care operations or where you specifically authorized a disclosure, when you submit a written request. The request must state the time period desired for the
    accounting, which must be less than a 6-year period and starting after April 14, 2003. You may receive the list in paper or electronic form. The first disclosure list request in a 12-month period is free; other requests will be charged according to our cost of producing the list. We will inform you of the cost before you incur any costs.
  • If this notice was sent to you electronically, you have the right to a paper copy of this notice.
  • You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home, by notifying us in writing of the specific way or location for us to use to communicate with you.
  • You may request, in writing, that we not use or disclose medical information about you for treatment, payment or healthcare operations or to persons involved in your care except when specifically authorized by you, when required by law, or in an emergency. We will consider your request but we are not legally required to accept it. We will inform you of our decision on your request.

Who abides by this notice
This notice applies to more than one covered entity. The covered entities or class of entities to which this notice applies are:

  • Any health care professional authorized to enter information into or consult your medical record.
  • All departments, units, employees, medical staff and contracted healthcare workers of RepuCare, Inc.
  • Any members of a volunteer group we allow to help you.
  • The anesthesiologists, pathologists, cardiologists, radiologists, radiation
    oncologists, and emergency room physicians.
  • Members of Mid America Clinical Laboratories, who provide laboratory services for RepuCare, Inc.
  • Associates of The Care Group and The Heart Center of Indiana.

All these entities, sites and locations follow the terms of this Notice. In addition, these entities, sites and locations may share information with each other for treatment, payment or operations purposes described in this Notice.

Disclosures of Medical Information of Minors:
Under Indiana law, we cannot disclose the medical information of minors to non-custodial parents if a court order or degree is in place that prohibits the non-custodial parent from receiving such information. However, we must have documentation of the court order prior to denying the non-custodial parent such access.
All written requests or appeals should be submitted to our Privacy Office listed at the bottom of this notice.
If you are concerned that your privacy rights have been violated, or you disagree with a decision we made about access to your records, you may contact our Privacy Office (listed below).
Finally, you may send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. Our Privacy Office can provide you the address. Under no circumstance will you be penalized or retaliated against for filing a complaint.

Privacy Official:
Sarah Morrison
Vice President of Health Centers